Consumption of certain food additive emulsifiers may be associated with the risk of developing type 2 diabetes

In Europe and North America, 30 to 60% of dietary energy intake in adults comes from ultra-processed foods. An increasing number of epidemiological studies suggest a link between higher consumption levels of ultra-processed foods with a higher risk of diabetes and other metabolic disorders.

Emulsifiers are among the most commonly used additives. They are often added to processed and packaged foods, such as certain industrial cakes, cookies and desserts, as well as to yoghurt, ice cream, chocolate bars, industrial breads, margarines and ready-made or ready-to-eat meals, to enhance the taste improve. to improve their appearance, taste and texture and extend shelf life. These emulsifiers include, for example, mono- and diglycerides of fatty acids, carrageenans, modified starches, lecithins, phosphates, celluloses, gums and pectins.

As with all food additives, the safety of emulsifiers has previously been evaluated by food safety and health authorities based on the scientific evidence available at the time of their evaluation. However, some recent research suggests that emulsifiers may disrupt the gut microbiota and increase the risk of inflammation and metabolic disturbances, potentially leading to insulin resistance and the development of diabetes.

For the first time worldwide, a team of researchers in France studied the relationships between dietary intake of emulsifiers, assessed over a follow-up period of up to 14 years, and the risk of developing type 2 diabetes in a large study in the general. population. The work appears in The Lancet Diabetes & Endocrinology.

The results are based on the analysis of data from 104,139 adults in France (average age 43 years; 79% women) who participated in the NutriNet-Santé web cohort study between 2009 and 2023.

Participants completed dietary data for at least two days, collecting detailed information on all foods and beverages consumed and their commercial brands (in the case of industrial products). This nutritional data was repeated every six months for fourteen years and compared to databases to identify the presence and amount of food additives (including emulsifiers) in the products consumed. Laboratory tests were also conducted to obtain quantitative data. This allowed chronic exposure to these emulsifiers to be measured over time.

During follow-up, participants reported the development of diabetes (1,056 diagnosed cases), and the reports were validated using a multi-source strategy (including data on diabetes medication use). Several known risk factors for diabetes, including age, sex, weight (BMI), education level, family history, smoking, alcohol and physical activity, as well as the overall nutritional quality of the diet (including sugar intake) were examined. included in the analysis.

After an average follow-up of seven years, the researchers found that chronic exposure – assessed on a repeat data basis – to the following emulsifiers was associated with an increased risk of type 2 diabetes:

• carrageenan (total carrageenan and E407; 3% increased risk per 100 mg dose per day)

• tripotassium phosphate (E340; 15% increased risk per dose of 500 mg per day)

• mono- and diacetyl tartaric acid esters of mono- and diglycerides of fatty acids (E472e; 4% increased risk per dose of 100 mg per day)

• sodium citrate (E331; 4% increased risk per dose of 500 mg per day)

• guar gum (E412; 11% increased risk per dose of 500 mg per day)

• Gum arabic (E414; 3% increased risk per dose of 1,000 mg per day)

• xanthan gum (E415; 8% increased risk per 500 mg dose per day)

This study represents an initial exploration of these relationships, and further research is now needed to establish causal relationships. The researchers cited several limitations of their study, such as the predominance of women in the sample, a higher level of education than the general population, and generally more health-promoting behaviors among the participants in the NutriNet-Santé study. Therefore, caution is advised when extrapolating the conclusions to the entire French population.

Nevertheless, the study is based on a large sample size, and the researchers took into account many factors that could have led to confounding biases. They also used unique, detailed data on exposure to food additives, down to the commercial brand name of the industrial products consumed. Furthermore, the results remain consistent across different sensitivity analyses, which strengthens their reliability.

“These findings are preliminary from one observational study and cannot be used on their own to establish a causal relationship. They need to be replicated in other epidemiological studies around the world, and supplemented with toxicological and interventional experimental studies, to inform further. the mechanisms linking these food additive emulsifiers and the onset of type 2 diabetes. However, our results represent important elements to enrich the debate on the re-evaluation of regulations surrounding the use of additives in the food industry, in order to better protect consumers. explain Mathilde Touvier, research director at Inserm, and Bernard Srour, junior professor at INRAE, lead authors of the study.

Among the next steps, the research team will look at variations in certain blood markers and the gut microbiota associated with the consumption of these additives, to better understand the underlying mechanisms. The researchers will also look at the health effects of additive mixtures and their potential ‘cocktail effects’. They will also work with toxicologists to test the impact of these exposures in in vitro and in vivo experiments, to build more arguments in favor of a causal relationship.